Provider Demographics
NPI:1992015598
Name:OLDE SEVILLE CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:OLDE SEVILLE CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:JEUDEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-607-2105
Mailing Address - Street 1:208 S. ALCANIZ ST.
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-6012
Mailing Address - Country:US
Mailing Address - Phone:850-607-2105
Mailing Address - Fax:
Practice Address - Street 1:208 S. ALCANIZ ST.
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-6012
Practice Address - Country:US
Practice Address - Phone:850-607-2105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9655111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty